An inquest into the death of a young mother who died a week after she gave birth to her third child at a maternity hospital in Dublin has heard claims there were "many missed opportunities" to diagnose that she had contracted a life-threatening infection.
Karen McEvoy, 24, of Red Bog, Blessington, Co Wicklow was rushed to Naas General Hospital with suspected sepsis on Christmas Day 2018.
Ms McEvoy was taken there seven days after her daughter, Ruby, had been born at the Coombe Women and Infants University Hospital.
She died a short time later after suffering a cardiac arrest in the hospital's emergency department.
An inquest at Kildare Coroner's Court today heard evidence from several witnesses that Ms McEvoy had complained of pains since 20 December 2018, the day after getting home from the maternity hospital, which got progressively worse over the following days.
Ms McEvoy’s partner, Barry Kelly, said she had been in great health during the pregnancy and there had been nothing out of the ordinary in Ruby’s delivery.
He said Ms McEvoy had been seen by a public health nurse, Doreen O’Sullivan, on 21 December 2018.
She went to the Coombe two days later, where she was told she was suffering from sciatica and advised to go to Tallaght Hospital if the pain was still continuing after two more days.
However, Mr Kelly said she remained very sore, drowsy and found it difficult to sleep over the next few days.
He recalled her condition was so bad when she woke up on Christmas Day with slurred speech, her whole body swollen and looking pale that he got his mother to call for an ambulance.
"Karen begged me not to touch her she was in so much pain," said Mr Kelly.
The inquest heard that Ms McEvoy suffered a cardiac arrest as emergency staff were trying to fit an intravenous line into her at Naas General Hospital.
"Karen was the best. She deserved the best," he added.
Questioned by his own counsel, Richard Kean SC, Mr Kelly said they had received no awareness information from the Coombe about post-natal sepsis.
Asked if they had been reassured by their visit to the Coombe on 23 December 2018, Mr Kelly said they had trusted the judgement of doctors.
His mother, Tina Kelly, said Ms McEvoy's death was "a complete shock" to her and her family.
"There were so many missed opportunities to pick up the issue of sepsis," said Ms Kelly.
She pointed out how Ms McEvoy had felt reassured at being told that abdominal pain was normal for "a new mother" and by being informed she had sciatica by doctors in the Coombe.
In evidence, however, the public health nurse said Ms McEvoy had not reported any discomfort during an abdominal examination in the Vista Clinic in Naas on 21 December 2018.
Ms O’Sullivan said she did not recall saying anything about abdominal pain being normal for new mothers.
The coroner, Professor Denis Cusack, said the nurse's failure to record whether the patient was suffering any pain in her medical notes was "a strange omission".
However, Ms O'Sullivan said it was a "straightforward" omission, which she could not explain.
The nurse said she would have activated a care plan if Ms McEvoy had expressed any concern about suffering pain, but the patient had presented as "tired but well".
Cross-examined by counsel for Mr Kelly, Esther Early, Ms O'Sullivan said she had not checked any of Ms McEvoy’s vital signs during an examination that lasted 45 minutes because she did not have the equipment to do so.
She also acknowledged that she was wrong to state that she had placed her "hands" on the patient’s stomach as she admitted that she had held baby Ruby with one hand while examining Ms McEvoy.
However, Ms O'Sullivan said she was confident she had carried out a competent abdominal examination at the time.
The inquest heard that there had been a number of changes to post-natal care in the healthcare services as a result of "lessons learned" from Ms McEvoy's death.
Counsel for the HSE and the two hospitals, Conor Halpin SC, said it was planned that public health nurses would be provided with equipment to check vital signs in patients and such a programme was being piloted in three locations.
Mr Halpin said new draft national guidelines on post-natal care were due to be signed off in the next few weeks, which would recommend that all examinations of new mothers by public health nurses should be conducted in the patient’s home.
The inquest heard a discharge information pack provided to new mothers leaving the Coombe at the time contained information about infections, but no specific reference to sepsis.
However, leaflets referencing sepsis were subsequently included in the pack, while new mothers are also advised to seek further information on the infection on the HSE website.
A trainee midwife, Sarah Glennon, who oversaw the discharge of Ms McEvoy from the Coombe on 19 December 2018, said the patient had displayed no signs of sepsis.
Ms Glennon said Ms McEvoy had a pain score of 5-6 out of 10, which she felt was not unusual for a woman one day after a delivery.
She said she believed "a slightly high heart rate" of 104 beats per minute was due to either the pain or some blood clots that the patient had experienced.
Ms Early said the rate was a significant increase over levels of 63 to 77 recorded the previous day, but had not been measured again before Ms McEvoy was discharged.
A paramedic, William O’Neill, who transported Ms McEvoy to hospital, said she was clearly unwell and had displayed several markers of sepsis and appeared in septic shock.
Prof Cusack said that recordings by the paramedic showing Ms McEvoy had a very fast pulse and breathing rate demonstrated "very significantly deranged vital signs".
The coroner praised the National Ambulance Service for displaying notices about sepsis on the side of ambulances.
The inquest heard Ms McEvoy died from multiple organ failure as a result of sepsis infection.
The pathologist, Dr Michael Jeffers, said Ms McEvoy would have had the infection for "at least 24 to 48 hours".
The inquest before a jury of five men and two women at Athy Courthouse continues tomorrow.